Although no human polio cases have been identified, environmental surveillance indicates that Israel has active poliovirus circulation. CDC is now recommending an adult polio vaccine booster dose for travelers to Israel.

Currently, endemic poliovirus circulation has never been interrupted in only 3 countries: Afghanistan, Nigeria, and Pakistan. Still, the affected areas within each of these countries have become smaller.

Because of the substantial progress of the polio eradication initiative in 2012–2013, and in order to harmonize CDC recommendations with World Health Organization (WHO) recommendations, CDC now recommends an adult IPV booster dose only for travelers to countries with active poliovirus circulation.

Countries are considered to have active poliovirus circulation if they have ongoing endemic circulation, active polio outbreaks, or environmental evidence of active wild poliovirus circulation.

In addition, CDC recommends an adult IPV booster dose for certain travelers to some countries that border areas with active poliovirus circulation. These recommendations are based on evidence of historical cross-border transmission.

The recommendations apply only to travelers with a high risk of exposure to someone with imported wild poliovirus (WPV) infection. These travelers would include those working in health care settings, refugee camps, or other humanitarian aid settings.

Comments: Even though India has polio free for more than 2 years now (last wild polio case was in Jan 2011), it is important to remember that we border two (out of a total of only 3 countries) of the countries that still have active Polio cases, namely Pakistan & Afghanistan. Hence, it is recommended for travelers coming to India to still ensure that they take a single dose of Polio vaccine when coming to India. TravelSafe clinics across the country provide IPV for travelers at a very affordable price (approximately USD 10 per dose).

Friday, August 30, 2013

Government has expressed concern following reports that have emerged of United Nations World Tourism Organization (UNWTO) foreign delegates who have been delayed entry into Zambia by South African government for not having certificates of yellow fever vaccine.

Health minister Dr. Joseph Kasonde, says a bilateral meeting was held on May 21, 2013 during the World Health Organization (WHO) general assembly in Geneva between the Ministry of Health, South Africa and the Ministry of Health, Zambia where South Africa indicated and stated that transit passengers en-route to and from Zambia will not be required to produce certification of yellow fever vaccination.

Dr. Kasonde says he is very concerned about stories that are emerging from visitors in Livingstone who have come to attend the UNWTO general assembly.

He explains that he understands that some of them are delayed because our South African authorities were in doubt about transit through South Africa without certificate of yellow fever vaccinationDr. Kasonde adds that any inaccurate information concerning the certification of yellow fever vaccination should be avoided so that foreign delegates are furnished with accurate information as agreed during the bilateral meeting in Geneva.

The minister stresses that there are many visitors coming from all over the world visiting Zambia and as such they should not be fed with inaccurate information concerning the certification of yellow fever vaccination.

Dr. Kasonde says the correct information is that we had discussions with the minister of health of South Africa in May this year in Geneva at the WHO where South Africa%u2019s Health Minister indicated that there will be no need for transit passengers (less than 24hours) en-route to and from Zambia to provide certification of yellow fever vaccination.

Dr. Kasonde further disclosed that during the general assembly in Geneva it was made known that the yellow fever booster injection is no longer necessary.

It was noted that yellow fever vaccination has now been proved to confer lifetime immunity and the booster injection currently given after 10 years is no longer necessary.

The Minister has since assured the visiting delegates to feel secure, adding that what transpired in South Africa, where some foreign visitors in transit to Zambia were delayed, will not reoccur.Source: QFM

- See more at: http://ukzambians.co.uk/home/2013/08/25/govt-is-worried-about-delays-of-delegates-for-yellow-fever-certification-in-sa-to-zambia-dr-kasonde/#sthash.86YnhV1u.dpufComments: While Zambia remains low risk for Yellow Fever, people transiting through have been subjected to harassment by the Immigration authorities if they do not have a Yellow Fever Vaccination certificate. Given that there may remain a small risk of flight delay, or extended stay in a YF endemic country airport, it is always preferable for travelers to plan for this vaccine BEFORE traveling to African countries that may have risk of Yellow Fever Disease.

Nigeria's Minister of Health, Prof. Onyebuchi Chukwu, has urged travellers who were still using the old yellow [yellow fever (YF) vaccination] card to replace it with the new encoded one. Chukwu, while addressing newsmen in Abuja, said that foreign countries had been informed not to recognise the old card by 1 Oct 2013.

He said: "We are giving new cards now; please don't accept any old card as a fresh person if you get immunised today. If you are vaccinated against yellow fever, demand the yellow card, the new one. Now, the question will be what about those people who are vaccinated for whom their immunisation is still current? If you even bring it to the Ministry of Health today, go to the Department of Public Health, and it will be replaced. If their marking tells us you bought it, if you bought it, we will vaccinate you; the process is N 1000 [USD 6.18] only. Nobody should cause you to pay more; we will vaccinate you here in the ministry, and we will give you the correct yellow card. If the old one you bring shows clearly you actually were vaccinated properly, we will just give you the new one and put all the documentation aright. So, 1 Oct 2013 is the date we have set so far; after that date, the old one will not be recognised."

Chukwu said that earlier, states and the private sector were printing the card, "but now it is only the Federal Ministry of Health that is printing the card." He added that in terms of distribution, the ministry issued to only the National Primary Health Care Development Agency because it had the vaccines. "The other sector that also gets the card from the ministry is the Port Health Authority, which also does the vaccination, and they belong to the Federal Ministry of Health," Chukwu said.

The minister said children who were immunised routinely would not need the card except if they were travelling out of the country. According to him, those who need the yellow card are people who intend to travel outside the country.

--Communicated by:ProMED-mail

[The sale of fake yellow fever vaccination cards to individuals who did not receive the vaccine presents a serious public health problem. Susceptible, unvaccinated individuals can contribute to a YF outbreak. YF virus is endemic in Nigeria. Unless the situation has changed recently, Nigeria is at risk for yellow fever outbreaks because it is the only country among 13 in West Africa yet to conduct mass vaccination, as was indicated in a ProMED-mail post of 24 Oct 2012 (archive no. 20121026.1366454). One hopes that the Ministry of Health's initiative to issue new cards, accompanied by vaccination, or replacement cards for old, legitimate ones will rectify the earlier problem of fake cards.

Comments: In india too there have been reports of fake cards of Yellow Fever vaccination being given, even though the minister of health has denied it in Parliament. To protect oneself & the country, it is very important that everyone takes the vaccine before going to a Yellow Fever endemic country. Remember this is a disease that can KILL.

JAPANESE ENCEPHALITIS & OTHER- INDIA (15): (KERALA)***************************************************A ProMED-mail posthttp://www.promedmail.orgProMED-mail is a program of theInternational Society for Infectious Diseaseshttp://www.isid.org

A serious threat of Japanese encephalitis (JE) or West Nile (WN) virus outbreak looms large over Alappuzha district [Kerala state], which is prone to water stagnation and consequent mosquito menace post-monsoon.

The National Institute of Virology (NIV) Alappuzha unit reported to the district health administration in the beginning of July [2013] that the cerebrospinal fluid (CSF) samples from 28 patients with acute encephalitis syndrome (AES) -- all dead -- had tested positive for the JE-WN complex. But the State Health authorities had been unaware of this till the end of July 2013, when a Central team of public health officials, led by Kalpana Barua, visited the State. Public experts have sounded the alert already, as a significant number of AES cases reported in the district in May-July [2013] have tested positive for the JE-WN complex.

Strange enough, the district health administration had maintained that these 28 deaths could not be considered "cases" of JE-WN complex because the clinical symptoms of the patients did not meet the classic definition of AES.

According to them, the district had only about 30-plus cases of AES since May [2013], leading to 4 deaths, which had been reported to the State health administration.

Senior health officials have pointed out that regardless of whether the 28 persons died from JE-WN or not, the laboratory findings about the presence of the twin infections in so many persons have huge public health significance, which cannot be ignored.

"Alappuzha district has been endemic to JE, WN, dengue, and other mosquito-borne diseases for long. In the past 2-3 years, we have had many cases of encephalitis, most of which could be either JE or WN because it is difficult to distinguish using clinical symptoms or lab diagnosis. Both cause serious neurological diseases and leave the patients with severe 'sequelae,' including cognitive dysfunction, memory loss, or epileptic episodes. The seriousness of the situation cannot be diluted," B Padmakumar, Additional Professor of Medicine, Government Medical College, Alappuzha, says.

The JE and WN viruses belong to the same family of flaviviruses and are zoonotic infections maintained in a cycle involving migratory birds, mammals such as pigs and horses, and the _Culex_ species of mosquitoes, which breed in stagnant water. JE was first reported in Alappuzha in 1996, and till 1999, there have been major outbreaks.

Between 2005 and 2009, very few confirmed cases of JE were reported from Alappuzha, which the Health Department admits was probably because of the problems in properly diagnosing and confirming the disease. All cases involving high fever, convulsions, and altered sensorium were reported by the health system as AES.

"Both JE and WN are antigenically similar (viral antigen properties are similar) and complex genotyping is required to distinguish either. Immunoglobulin M (IgM) testing of CSF samples of an encephalitis patient gives only the confirmation as JE-WN or any other flavivirus. Virus neutralisation assay is required to differentiate between JE or WN, which could be time-consuming," says B Anukumar, scientist in-charge of the NIV wing at Alappuzha.

From the public health point of view, it is important that JE and WN surveillance is started in all districts and steps to contain it are intensified, Dr Anukumar says. JE mostly affects children less than 15 years, while WN usually affects older adults. In 2006, during the major chikungunya [virus] epidemic in Alappuzha, some scientists had raised the possibility of the co-circulation of WN virus because of the high rate of mortality during the epidemic.

However, NIV gave conclusive evidence about the major presence of WN virus in the region in 2011 during an AES outbreak when 208 cases were reported.

The district health administration has pointed out that the 28 patients who died from JE-WN, as reported by the NIV, were all elderly persons with various co-morbidities and that they did not have any AES symptoms. "Lab findings should have clinical correlation also. These persons are living in an endemic area where various flaviviruses are in circulation. It is possible that they were infected by JE-WN viruses, which came up in the lab diagnosis. It does not mean that those persons died of JE or WN," a senior official in Alappuzha says.

The NIV has clarified that all samples of the CSF that they had tested were of patients who had encephalitis meningitis symptoms. The samples were sent from the Alappuzha Medical College hospital.

"We just tested the CSF samples we received and reported our findings. It is possible that the patients presented a different spectrum of clinical symptoms, which did not fit into the classical definition of AES. The mean age of the patients was 60 years. We have not reported that the 28 deaths were due to JE/WN, but that these persons were exposed to the JE/WN viruses and that IgM positivity of the CSF indicates acute exposure. It is for the Health department to take suitable follow-up action," says Dr Anukumar.

[Byline: C Maya]

--Communicated by:ProMED-mail from HealthMap Alerts

[Both West Nile virus (WNV) and Japanese encephalitis virus (JEV) occur in southern India, and it is possible that these patients could have been infected with either one, although that diagnosis is disputed by the district public health administration. The diagnoses were made on the basis of serology, the interpretation of which is confounded by flavivirus cross reactivity, as mentioned in the report above.

No mention was made about attempts to detect virus sequences by PCR. Although virus neutralization tests may be too slow to provide a diagnosis for patients while they are hospitalized, it is critical to know which viruses are circulating in the area, and that requires neutralization testing.

There is a vaccine available for JEV but not for WNV. The report above makes no mention of the vaccination history of the patients, or of plans to vaccinate others in the areas where the patients acquired their infection should further testing indicate that JEV is circulating there.

Comments: Now we have easy availability of JE vaccine in India - JEEV, which is similar to IXIARO and made in collaboration with Intercell (makers of Ixiaro). I would urge all foreign travelers who are planning to stay in Kerala for any prolonged period of time to take this vaccine from a Travel clinic either before coming to India, or after reaching here. We have TravelSafe Clinics located in Delhi, Mumbai & Chandigarh who can provide 2 doses of JE vaccine at a gap of 28 days to provide long term immunity lasting years. If you have taken 1 dose of IXIARO, you can complete the second dose with JEEV, as per verbal communication with the representatives of the manufacturers.

Monday, August 26, 2013

ProMED-mail is a program of the International Society for Infectious Diseases: August 26, 2013

Dominican health authorities yesterday, 23 Aug 2013, confirmed a new cholera outbreak in San Cristobal (about 30 km [18.6 mi] west of Santo Domingo), after the epidemic that has been ongoing in Haiti since October 2010.

According to Eulogio Acosta, San Cristobal hospital director of emergency, 23 people have been hospitalized this week due to the disease, none of whom have died.

The Health Ministry issued a 1st level alert in San Cristobal and surrounding towns, and set up a special unit to treat new cholera cases in the area.

Has chikungunya [virus] made a comeback in the city [Ahmedabad]? After the civic body and the government tried their best to control the figures, the disease seems to be back again. Members of the Ahmedabad Municipal Corporation's (AMC) health committee on Monday [5 Aug 2013] discussed how the various diseases were increasing in the city.

According to figures obtained from the civic body, the city witnessed 43 cases of chikungunya [virus infections] last year (January 2012-December 2012). Surprisingly, 20 cases of chikungunya were reported this July [2013] alone, which is nearly 50 per cent of last year's total in just one month! Also, 39 cases of chikungunya have been reported from January to July this year [2013]. However, no deaths have been reported this year.

--communicated by:ProMED-mail from HealthMap Alerts

[The report above does not indicate if these reported cases have been confirmed by laboratory. There have been outbreaks of chikungunya virus infection in Karnataka state this year (2013). The virus is endemic in India, so it is not surprising that there are sporadic outbreaks in various parts of the country.

The dengue fever epidemic appears to be on the decline, but the spread of another mosquitoborne disease is still going strong. Close to 500 people have been infected with chikungunya [virus] this year -- compared with a total of 60 cases in the 3 years between 2010 and last year [2012].

In the week ending 3 Aug [2013], 21 people were infected -- 16 in the Bukit Timah area, one in Jalan Papan in the Jurong area, and one in Woodlands Industrial Park, said a spokesman for the Ministry of Health.

Although it is not known where the other 3 people were bitten, none of them had been overseas recently.

[byline: Salma Khalik]

--communicated by:ProMED-mail from HealthMap Alerts

[The number of chikungunya virus infections in Singapore continues to climb steadily. On 25 May 2013, 184 cases were reported. Now, there are nearly 500. No mention is made about what, if any, vector mosquito control measures are being taken. If dengue virus infections have been ruled out in these cases, those reported as chikungunya virus infections are presumably laboratory confirmed.

Monday, August 12, 2013

Thane resident Rajesh Iyer cancelled his plans to visit Kenya during the Diwali vacations and the reasons were not the usual falling rupee or rising prices, but the lack of yellow fever vaccine in Mumbai. It is mandatory to take the vaccination before applying for a visa to central African and South American destinations.

“I got tired of the back and forth in getting the vaccination,” said Iyer, who was to travel in a group of 12 people. He will now head to either Mauritius or South Africa.

According to travel agents in the city, officials at the two vaccination centres in Mumbai have been turning down passengers claiming to have run of out vaccine stock. “I had clients who queued up twice and were turned away,” said Vasuki Sundaram, owner of Wings Travel, adding that at least four families planning a trip to Africa have now settled for other destinations.

The problem is not just in Mumbai, but in other metros as well. “I have six families held up because yellow fever vials have not been available for two weeks,” said Sampat Kumar, a travel agent from Bangalore. Kumar said some of them had made advance payments and were now left in a lurch.

Mumbai airport sources claimed that touts at the airport premises have been selling vials for Rs. 5000 each, while the actual cost is Rs. 300.Thane resident Rajesh Iyer cancelled his plans to visit Kenya during the Diwali vacations and the reasons were not the usual falling rupee or rising prices, but the lack of yellow fever vaccine in Mumbai. It is mandatory to take the vaccination before applying for a visa to central African and South American destinations.

The problem is not just in Mumbai, but in other metros as well. “I have six families held up because yellow fever vials have not been available for two weeks,” said Sampat Kumar, a travel agent from Bangalore. Kumar said some of them had made advance payments and were now left in a lurch.

Mumbai airport sources claimed that touts at the airport premises have been selling vials for Rs. 5000 each, while the actual cost is Rs. 300.

About Me

I am a pediatrician based at Mohali, a suburb of chandigarh, North India. I have my own virtual office at www.charakclinics.com; I have been a pediatrician since 1994. I hope to make ths blog a regular feature with tonnes of relevant info for parents, especially in India, because i feel that "informed parents are better parents". My interests include research in OPD practice, specifically new vaccines and travel medicine. I am a member of American Academy of Pediatrics, Indian Academy of Pediatrics, and various travel organizations like International Society for Travel Medicine (ISTM), American Society of Tropical Medicine & Hygiene (ASTMH), International Association for Medical Assistance to Travelers (IAMAT), and British & Global Travel Health Association (BGTHA)